A N A C T
RELATING TO RESIDENTIAL CARE AND ASSISTED LIVING FACILITY LICENSING ACT
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 23-17.4 of the General Laws entitled "Residential Care and Assisted Living Facility Licensing Act" is hereby amended by adding thereto the following sections:
23-17.4-15.5. Initial evaluation and service plan. -- (a) Prior to admission of a prospective resident, an agent of the facility shall conduct an evaluation to determine the facility's ability to meet the prospective resident's needs and preferences.
(b) Within a reasonable time after admission to a facility, each resident shall have a written service plan put in place based on an initial evaluation and periodic review of the resident's health, physical, social, functional, activity and cognitive needs and preferences that is developed with the input of the resident and their family and friends, if requested by the resident, and signed by the resident and facility agent. The service plan shall (1) include the identified need for services and the type, frequency and duration of services or interventions to be provided, arranged for, or coordinated by the facility and any responsibility for service arrangement and management that will be the responsibility of the resident, and (2) be reviewed at least annually or at any time that the resident's needs change substantially and revised as appropriate.
23-17.4-16.3. Residency agreement or contract. - Prior to or as part of the admission procedure, the facility shall execute a residency agreement or contract, signed by both the facility and the resident, that defines the services the facility will provide and the financial agreements between the facility and the resident.
23-17.4-34. Name change. - Wherever in the general or public laws there appear the words "Residential Care and Assisted Living Facility," it shall now read, "Assisted living residence."
SECTION 2. Sections 23-17.4-2 and 23-17.4-16 of the General Laws in Chapter 23-17.4 entitled "Residential Care and Assisted Living Facility Licensing Act" is hereby amended to read as follows:
23-17.4-2. Definitions -- As used in this chapter:
(1) "Administrator" means any person who has responsibility for day to day administration or operation of a residential care/assisted living facility.
(2) "Alzheimer's special care unit" means any residential care and assisted living facility that locks, secures, segregates, or provides a special program or a special unit for residents with a diagnosis of probable Alzheimer's or a related disorder, to prevent or limit access by a resident outside the designated or separated area; and that advertises or markets the facility as providing specialized Alzheimer degrees dementia care services.
(3) "Capable of self-preservation" means the physical mobility and judgmental ability of the individual to take appropriate action in emergency situations. Residents not capable of self-preservation are limited to facilities that meet more stringent life safety code requirements as provided under section 23-17.4-6(b)(3).
(4) "Director" means the director of the Rhode Island department of health.
(5) "Licensing agency" means the Rhode Island department of health.
(6) "Personal assistance" means the provision of twenty-four (24) hour adult staffing of the home, and of one or more of the following services, as required by the resident or as reasonably requested by the resident, on a scheduled or unscheduled basis, including:
(i) Assisting the resident with personal needs;
(ii) Assisting the resident with self-administration of medication or administration of medications by appropriately licensed staff;
Assisting Providing or assisting the resident in arranging for health and supportive services as may be reasonably required;
(iv) Monitoring the activities of the resident while on the premises of the residence to ensure his or her health, safety, and well-being; and
(v) Reasonable recreational, social and personal services.
(7) "Resident" means an individual who is an adult, not requiring medical or nursing care as provided in a health care facility but may require the administration of medication and who as a result of age, and/or physical or mental limitation requires personal assistance, lodging and meals. A resident must be capable of self-preservation in emergency situations, unless the facility meets a more stringent life safety code as required under section 23-17.4-6(b)(3).
(8) "Residential care and assisted living facility" means a publicly or privately operated residence that provides directly or indirectly by means of contracts or arrangements personal assistance to meet the resident's changing needs and preferences, lodging, and meals to two (2) or more adults who are unrelated to the licensee or administrator, excluding however, any privately operated establishment or facility licensed pursuant to chapter 17 of this title, and those facilities licensed by or under the jurisdiction of the department of mental health, retardation, and hospitals, the department of children, youth, and families, or any other state agency. Residential care and assisted living facilities include sheltered care homes, and board and care residences or any other entity by any other name providing the above services which meet the definition of residential care and assisted living facilities.
23-17.4-16. Rights of residents -- (a) Every residential care/assisted living facility for adults licensed under this chapter shall observe the following standards and such other standards as may be prescribed in rules and regulations promulgated by the licensing agency with respect to each resident of the facility:
(1) Residents are entitled to all rights recognized by law with respect to discrimination, service decisions (including the right to refuse services), freedom from abuse and neglect, privacy, association, and other areas of fundamental rights including the right to freedom of religious practice. Some of these basic rights include:
(i) To be offered care without discrimination as to sex, race, color, religion, national origin, or source of payment;
(ii) To be free from verbal, sexual, physical, emotional, and mental abuse, corporal punishment, and involuntary seclusion;
(iii) To be free from physical or chemical restraints for the purpose of discipline or convenience and not required to treat the resident's medical symptoms. No chemical or physical restraints will be used except on order of a physician;
(iv) To have their medical information protected by applicable state confidentiality laws;
(v) To have a service animal, consistent with the "reasonable accommodations" clause of the Fair Housing Act [42 U.S.C. section 3601] (such as a seeing eye dog); and
(2) In addition to these basic rights enjoyed by other adults, the residents of assisted living also have the right to:
(i) Be treated as individuals and with dignity, and be assured choice and privacy and the opportunity to act autonomously;
(ii) Upon request have access to all records pertaining to the resident, including clinical records, within the next business day or immediately in emergency situations;
(iii) Arrange for services not available through the setting at their own expense as long as the resident remains in compliance with the resident contract and applicable state law and regulations;
(iv) Upon admission and during the resident's stay be fully informed in a language the resident understands of all resident rights and rules governing resident conduct and responsibilities. Each resident shall:
(A) Receive a copy of their rights;
(B) Acknowledge receipt in writing; and
(C) Be informed promptly of any changes;
(v) Remain in their room or apartment unless a change in room or apartment is related to resident preference or to transfer conditions stipulated in their contract;
(vi) Consistent with the terms of the resident contract, furnish their own rooms and maintain personal clothing and possessions as space permits, consistent with applicable life safety, fire, or similar laws, regulations, and ordinances;
(vii) Be encouraged and assisted to exercise rights as a citizen; to voice grievances through a documented grievance mechanism and suggest changes in policies and services to either staff or outside representatives without fear of restraint, interference, coercion, discrimination, or reprisal;
(viii) Have visitors of their choice without restrictions so long as those visitors do not pose a health or safety risk to other residents, staff, or visitors, or a risk to property, and comply with reasonable hours and security procedures;
(ix) Have personal privacy in their medical treatment, written communications and telephone communications, and, to the fullest extent possible, in accommodation, personal care, visits, and meetings;
(x) Have prominently displayed a posting of the facility's grievance procedure, the names, addresses, and telephone numbers of all pertinent resident advocacy groups, the state ombudsperson, and the state licensing agency;
(xi) Choose his or her own physician(s) and have ready access to the name, specialty, and way of contacting the physician(s) responsible for the resident's care;
(xii) Have the facility record and periodically update the address and telephone number of the resident's legal representative or responsible party;
(xiii) Manage his or her financial affairs. The facility may not require residents to deposit their personal funds with the facility. Upon written authorization of a resident and with the agreement of the facility, the facility holds, safeguards, manages, and accounts for personal funds of the resident as follows:
(A) Funds in excess of three hundred dollars ($300) must be in an interest bearing account, separate from any facility operating account, that credits all interest on the resident's funds to that account and the facility shall purchase a surety bond on this account;
(B) A full and separate accounting of each resident's personal funds maintained must be available through quarterly statements and on request of the resident;
(C) Resident funds shall not be commingled with facility funds or with funds of any person other than another resident;
(D) Upon the death of a resident, the facility must convey within thirty (30) days the resident's funds deposited with the facility and a full accounting of those funds to the resident's responsible party or the administrator of the resident's estate;
(xiv) Have access to representatives of the state ombudsperson and to allow the ombudsperson to examine a resident's records with the permission of the resident and consistent with state law;
(xv) Be informed in writing prior to or at the time of admission or
during his or her stay of: the signing of a residential contract or agreement of:
(A) The scope of the services available through the facilities service program, including health services, and of all related fees and charges, including charges not covered either under federal and/or state programs or by other third party payors or by the facility's basic rate;
(B) The facility's policies regarding overdue payment including notice provisions and a schedule for late fee charges;
(C) The facility's policy regarding acceptance of state and federal government reimbursement for care in the facility both at time of admission and during the course of residency if the resident depletes his or her own private resources;
(D) The facility's criteria for admission, occupancy and discharge;
(E) The facility's capacity to serve residents with physical and cognitive impairments;
(F) Support and health services that the facility includes in its service package or will make appropriate arrangements to provide therefor;
(xvi) To be encouraged to meet with and participate in activities of social, religious, and community groups at the resident's discretion;
(xvii) Upon provision of at least thirty (30) days notice, if a resident chooses to leave a facility, the resident shall be refunded any advanced payment made provided that the resident is current in all payments;
(xviii) To have the facility discharge a resident only for the following reasons and within the following guidelines:
(A) Except in life threatening emergencies and for nonpayment of fees and costs, the facility gives thirty (30) days' advance written notice of discharge with a statement containing the reason, the effective date of termination, and the resident's right to an appeal under state law;
(B) If resident does not meet the requirements for residency criteria stated in the residency agreement or requirements of state or local laws or regulations;
(C) If the resident is a danger to himself or herself or the welfare of others and the facility has attempted to make a reasonable accommodation without success to address the resident's behavior in ways that would make discharge or change unnecessary, which would be documented in the resident's records;
(D) For failure to pay all fees and costs stated in the contract, resulting in bills more than thirty (30) days outstanding. A resident who has been given notice to vacate for nonpayment of rent has the right to retain possession of the premises, up to any time prior to eviction from the premises, by tendering to the provider the entire amount of fees for services, rent, interest, and costs then due. The provider may impose reasonable late fees for overdue payment; provided that the resident has received due notice of those charges in accordance with the facility's policies. Chronic and repeated failure to pay rent is a violation of the lease covenant. However the facility must make reasonable efforts to accommodate temporary financial hardship and provide information on government or private subsidies available that may be available to help with costs; and
(E) The facility makes a good faith effort to counsel the resident if the resident shows indications of no longer meeting residence criteria or if service with a termination notice is anticipated;
(xix) To have the facility provide for a safe and orderly discharge, including assistance with identifying a resource to help locate another setting, regardless of reason for move out;
(xx) To have the resident's responsible person and physician notified when there is:
(A) An accident involving the resident which results in injury and required physician intervention;
(B) A significant change in the resident's physical, mental, or psychosocial status or treatment;
(xxi) To be able to share a room with a spouse or other consenting resident of the facility in accordance with terms of the resident contract;
(xxii) To live in a safe and clean environment;
(xxiii) To have and use his or her own possessions where reasonable and have an accessible lockable space provided for security of small personal valuables;
(xxiv) To receive a nourishing, palatable, well balanced diet that meets his or her daily nutritional and special medical dietary needs;
(xxv) To attain or maintain the highest practicable physical, mental, and psychosocial well being; and
(xxvi) To be allowed to maintain an amount of money to cover reasonable monthly personal expenses, the amount of which shall be at least equal to that amount required for individuals on SSI as provided under section 40-6-27(a)(3).
(xxvii) To have the facility implement written policies and procedures to ensure that all facility staff are aware of and protect the resident's rights contained in this section.
(b) For purposes of subdivisions (a)(2)(ii), (iv), (xi), (xiii), (xiv), (xvii), and (xviii)(A), the term "resident" shall also mean the resident's agent as designated in writing or legal guardian.
SECTION 3. This act shall take effect upon passage.